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Hypoperfusion in response to epinephrine in local anaesthetics : Investigation of dependence on epinephrine concentration, spread of hypoperfusion and time to maximal cutaneous vasoconstriction

Sheikh, Rafi LU ; Memarzadeh, Khashayar LU ; Torbrand, Christian LU ; Blohmé, Jonas LU and Malmsjö, Malin LU (2017) In Journal of Plastic, Reconstructive and Aesthetic Surgery2006-01-01+01:00 70(3). p.322-329
Abstract

Objectives: The present study aimed to examine hypoperfusion in response to epinephrine following the administration of a local anaesthetic. The . concentration of epinephrine that causes maximal hypoperfusion, the . spread of hypoperfusion in the tissue and the . time to the stabilization of hypoperfusion were investigated. Methods: Blood perfusion was monitored using laser Doppler velocimetry and laser speckle contrast imaging of random-pattern advancement flaps (1 × 4 cm) or intact skin on the pig flank. Epinephrine was either injected cumulatively (0.1, 1.0, 10 or 100 μg/ml) after injecting 20 mg/ml lidocaine, to determine the concentration response, or given as a single dose (12.5 μg/ml epinephrine. +. 20 mg/ml lidocaine). Control... (More)

Objectives: The present study aimed to examine hypoperfusion in response to epinephrine following the administration of a local anaesthetic. The . concentration of epinephrine that causes maximal hypoperfusion, the . spread of hypoperfusion in the tissue and the . time to the stabilization of hypoperfusion were investigated. Methods: Blood perfusion was monitored using laser Doppler velocimetry and laser speckle contrast imaging of random-pattern advancement flaps (1 × 4 cm) or intact skin on the pig flank. Epinephrine was either injected cumulatively (0.1, 1.0, 10 or 100 μg/ml) after injecting 20 mg/ml lidocaine, to determine the concentration response, or given as a single dose (12.5 μg/ml epinephrine. +. 20 mg/ml lidocaine). Control experiments were performed with saline or lidocaine (without epinephrine). Results: Increasing concentrations of epinephrine resulted in a gradual decrease in skin perfusion, approaching a minimum after injecting 10 μg/ml. The area of hypoperfusion was 12 mm in radius, and the time from the injection to the stabilization of hypoperfusion was approximately 120 s. After the administration of 10 μg/ml epinephrine in flaps with small pedicle, 25% blood perfusion still remained. Conclusions: Local anaesthetic with an epinephrine concentration of approximately 10 μg/ml appears to be adequate for vasoconstriction before surgery. Incisions were required to be delayed only for 2 min following local anaesthetic with epinephrine in pigs. The remaining 25% blood perfusion observed after the administration of epinephrine supports the use of epinephrine in flaps with a small pedicle. Obviously, these experimental findings must be clinically assessed before being considered for infiltration anaesthesia during plastic surgery procedures.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Epinephrine, Laser Doppler velocimetry, Laser speckle contrast imaging, Lidocaine, Local anesthetic, Perfusion
in
Journal of Plastic, Reconstructive and Aesthetic Surgery2006-01-01+01:00
volume
70
issue
3
pages
322 - 329
publisher
Elsevier
external identifiers
  • scopus:85007524523
  • wos:000398108900004
ISSN
1748-6815
DOI
10.1016/j.bjps.2016.10.017
language
English
LU publication?
yes
id
c0fe6fce-9c6b-41e6-8d7d-b75064eff509
date added to LUP
2017-01-18 16:42:09
date last changed
2018-01-07 11:45:36
@article{c0fe6fce-9c6b-41e6-8d7d-b75064eff509,
  abstract     = {<p>Objectives: The present study aimed to examine hypoperfusion in response to epinephrine following the administration of a local anaesthetic. The . concentration of epinephrine that causes maximal hypoperfusion, the . spread of hypoperfusion in the tissue and the . time to the stabilization of hypoperfusion were investigated. Methods: Blood perfusion was monitored using laser Doppler velocimetry and laser speckle contrast imaging of random-pattern advancement flaps (1 × 4 cm) or intact skin on the pig flank. Epinephrine was either injected cumulatively (0.1, 1.0, 10 or 100 μg/ml) after injecting 20 mg/ml lidocaine, to determine the concentration response, or given as a single dose (12.5 μg/ml epinephrine. +. 20 mg/ml lidocaine). Control experiments were performed with saline or lidocaine (without epinephrine). Results: Increasing concentrations of epinephrine resulted in a gradual decrease in skin perfusion, approaching a minimum after injecting 10 μg/ml. The area of hypoperfusion was 12 mm in radius, and the time from the injection to the stabilization of hypoperfusion was approximately 120 s. After the administration of 10 μg/ml epinephrine in flaps with small pedicle, 25% blood perfusion still remained. Conclusions: Local anaesthetic with an epinephrine concentration of approximately 10 μg/ml appears to be adequate for vasoconstriction before surgery. Incisions were required to be delayed only for 2 min following local anaesthetic with epinephrine in pigs. The remaining 25% blood perfusion observed after the administration of epinephrine supports the use of epinephrine in flaps with a small pedicle. Obviously, these experimental findings must be clinically assessed before being considered for infiltration anaesthesia during plastic surgery procedures.</p>},
  author       = {Sheikh, Rafi and Memarzadeh, Khashayar and Torbrand, Christian and Blohmé, Jonas and Malmsjö, Malin},
  issn         = {1748-6815},
  keyword      = {Epinephrine,Laser Doppler velocimetry,Laser speckle contrast imaging,Lidocaine,Local anesthetic,Perfusion},
  language     = {eng},
  number       = {3},
  pages        = {322--329},
  publisher    = {Elsevier},
  series       = {Journal of Plastic, Reconstructive and Aesthetic Surgery2006-01-01+01:00},
  title        = {Hypoperfusion in response to epinephrine in local anaesthetics : Investigation of dependence on epinephrine concentration, spread of hypoperfusion and time to maximal cutaneous vasoconstriction},
  url          = {http://dx.doi.org/10.1016/j.bjps.2016.10.017},
  volume       = {70},
  year         = {2017},
}